2024 Palliative Care Symposium – A focus on paediatric palliative care in Nigeria

Categories: Education.

The 2024 Palliative Care Symposium was held at Lagos University Teaching Hospital (LUTH) in Lagos, Nigeria from the 19th – 20th July 2024. This year the focus was on paediatric palliative care. Paediatric palliative care is still at its nascent stage in Nigeria, and to promote its development, the LUTH Palliative Care Unit, in collaboration with Northwestern University, hosted its second palliative care symposium with a focus on paediatrics. The symposium aimed to provide essential training for paediatric healthcare workers in Nigeria and was held at the Surgical Skills Centre LUTH and generously supported by the Bakalar Charitable Fund.

Forty-six participants attended the symposium from a wide range of settings including inpatient and outpatient clinical practices, community-based providers, non-profit organizations, and community members. The importance of a multi-disciplinary team in paediatric palliative care was underscored by the diverse range of professions represented among the attendees. This included doctors, nurses, chaplains, social workers, dietitians, psychologists, pharmacists, and physiotherapists. Their collective presence at the event demonstrated the comprehensive and collaborative approach required in this field. This was also reflected in the facilitators for the symposium who came from Nigeria, the USA and the UK, some of whom attended in person and others virtually. The lead for the symposium was Dr Ann Ogbenna, a Senior Lecture at the College of Medicine, University of Lagos (CMUL) and a Consultant Haematologist at LUTH. Alongside this she leads the palliative care team at the hospital, and her vision is to improve care through the provision of palliative care, giving individuals the right to quality of life even in their illnesses.

There was a packed programme for the symposium, with each session being facilitated by a Nigerian and International facilitator ensuring the topics were rooted in the Nigerian context, whilst learning internationally as well. Topics covered included:

  • What is Paediatric Palliative Care and why does it matter?
  • Multi-modal analgesia
  • Management of emotional and behavioural symptoms, Gastrointestinal symptoms and Respiratory symptoms
  • Preparation for imminent death
  • Communication and planning
  • Team collaboration and effectiveness
  • Spirituality
  • Grief and bereavement
  • Self-care
  • Teaching techniques and the development of a teaching plan

 

Group photo

The sessions were based around the EPEC-Pediatric modules, which were adapted for the Nigerian context. Dr Ann Ogbenna was joined by Rev Matthew Agi, Dr Seye Akinsete (University of Lagos – UNILAG), Dr Babatunde Akodu (UNILAG), Dr Ogundeyi Morufat Mojisola (Federal Medical Centre, Abeokuta and the Nigerian Society of Paediatric Oncology) and Prof Gracia Eke (University of Port Harcourt and University of Port Harcourt Teaching Hospital), bringing together a strong team for the discussions on palliative care for children. They were joined by Dr Ashti Doobay-Persaud (Northwestern University), Dr Joshua Hasuer (Northwestern University  and Jesse Brown Veterans Affairs Medical Center), Dr Justin Baker (Stanford University), Dr Elisha Waldman (Great Ormond Street Hospital), Dr Teresa Vente (Weill Cornell Medicine), Peter Bustzen (Ann and Robert H. Lurie Children’s Hospital) and Prof Julia Downing (International Children’s Palliative Care Network ICPCN). The mix of facilitators enabled some great discussions around paediatric palliative care, why it is important, the importance of a team, and the holistic nature of care. The session on self-care was important and highlighted many of the challenges experienced in Nigeria due to the migration of health workers out of the country combined with a freeze on recruitment.

Feedback from participants was good, and they all recognised the importance of, and need for paediatric palliative care in Nigeria, not just for children with cancer but for children with a wide range of conditions. Some comments from the participants included:

 

“It’s an awesome way of positioning a patient mind set positively to travel a journey of no return in this 21 first century.”

“Beautiful symposium, well put together, great delivery of lectures, lovely networking and good food”

“It was fantastic, well thought out and delivered. Strong and passionate faculty WELL DONE !!!”

 

In 2020, a transformative partnership was initiated between Northwestern University (NU) and Lagos University Teaching Hospital (LUTH). At the time, LUTH, despite being the host of the national cancer centre, lacked palliative care services. Recognising this gap, a project was launched to train providers in palliative primary care, utilising a multi-disciplinary approach through online and in-person training. Over the subsequent four years, the team hosted multiple trainings for all hospital faculty and staff locally and our focus was on building capacity by formally training nurses, doctors and social workers through the Hospice Africa Uganda both online and in-person. The initiative was met with such positive response within the hospital that it led to the official establishment of a palliative care unit in 2023. The establishment of this unit is considered one of the most impactful outcomes of our collaboration. Currently, consultations are underway, and a dedicated team has been formed to care for patients hospitalised at LUTH and we are committed to ongoing capacity building through education to support symposia such as these to create and disseminate knowledge and skills, build networks, build teachers and communities of practice.

When the consultation service started, it became clear that many patients were children and that it was imperative that we focus training and service on these paediatric patients which led to our symposium. This need became very apparent when we asked our attendees, all of whom care for children, about their experiences. Everyone agreed, with 80% strongly agreeing that there was a need for specific protocols and guidelines for their pediatric patients.

It is hoped that this symposium will lead on to other opportunities for training on, and the development of paediatric palliative care within Lagos and the surrounding areas. After the training Dr Ann Ogbenna, Dr Ashti Doobay-Persaud and Prof Julia Downing said:

Dr Ann Ogbenna

“My goal is to build capacity in the field of PC in Nigeria, so that every health care worker in Nigeria has the basic skill to provide PC to patients with Life threating disease. Nigeria has over 200 million people, this implies an estimated palliative care need of over 2 million. It is hence important that all health care workers in Nigeria have basic palliative care knowledge and skills.”  (Dr Ann Ogbenna, LUTH)

“It has been an honour and a privilege to be part of this journey to bring palliative care to the most populous city in Nigeria with over 20 million people who had no public options for palliative care. I’ve witnessed a seed of an idea grow into a flourishing unit, now providing care for special populations. The commitment, drive, and knowledge that have been shared and gained throughout this process are truly awe-inspiring. I am truly excited for our next steps as the service expands and grows from the inpatient to the outpatient and community settings.” (Dr Ashti Doobay-Persaud, Northwestern University)

“ICPCN was delighted to be invited to be part of this training – it was exciting to see the enthusiasm for paediatric palliative care, and the interest in how they can develop services and provide palliative care for children and their families, despite the challenge environment in which many of them work. I was energised and stimulated by the training and look forward to hopefully working with LUTH and Northwestern University in the future.” (Prof Julia Downing, ICPCN)

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